Скачать или смотреть Why walking again isn’t as simple as it seems after a stroke - Intricacies of walking - Part 1

Dr. Sam's Background [00:24]: Dr. Sam specializes in physical therapy and rehab coaching for post-stroke individuals, focusing on unique and specialized exercise programming, accountability, and scheduling to help them self-manage their recovery.

Common Walking Difficulties After Stroke [02:01]: The host shares his personal struggles, including drop foot, circumduction (swinging the leg outwards), double vision affecting balance, and fatigue. Dr. Sam categorizes common issues into four main areas:

Strength Issues [03:03]: Hemiparesis or lack of voluntary muscle control.

Balance Issues [03:21]: Unsteadiness in the upper body, core, and legs, and difficulty standing on one leg.

Coordination Issues [03:36]: Difficulties with motor planning and making smooth movements.

Endurance Issues [03:42]: General deconditioning from hospitalization and inefficient walking patterns that consume more energy.

Importance of Professional Evaluation [04:40]: Dr. Sam emphasizes that a physical therapist evaluates walking from the moment a patient enters the clinic, observing posture, device use, joint movements, and arm swing [07:31]. This comprehensive assessment helps identify the root cause of walking difficulties, such as drop foot leading to circumduction [06:36].

Remote Evaluation through Videos [08:21]: For remote assessments, Dr. Sam requests videos from all angles (forward, backward, and side views) to understand how walking is affected in different planes of motion.

Why Improve Walking? [11:44]: Beyond just being able to walk, improving speed and symmetry in gait leads to:

Lower risk of falls [11:56].

Increased efficiency, reducing fatigue [12:35].

Prevention of pain, overuse injuries, and orthopedic issues in the long term [12:41].

Evolution of Recovery [20:22]: Walking issues can change over time due to progression, setbacks, or changes in muscle tone. Continuous re-evaluation is crucial to adapt interventions and target new areas of improvement.

Q&A Highlights:

Ankle Weights for Balance [22:53]: Dr. Sam explains that ankle weights can help strengthen muscles for leg swing and improve proprioception (body awareness). However, their use depends on the individual's specific condition and should be challenging but not overwhelming, aiming for about three successful trials out of five [25:24].

Working on Ankle Movement [26:24]: Improving ankle movement depends on the underlying cause, such as muscle weakness (requiring strengthening), tone (requiring management and stretching), or stability (requiring work on uneven surfaces).

Managing Muscle Spasms and Nerve Pain [27:45]: Dr. Sam suggests consulting a doctor for nerve pain medication or muscle relaxers. She also recommends exploring chronic pain techniques, including exposure therapy like light touch or rubbing the affected area to rewire the brain's perception of pain.